« Occiput Posterior (posterior, sunny side up, OP etc) »
Wednesday, August 3, 2011 at 8:16AM During your pregnancy, you will have felt tiny taps and flutters, then the rapping of a foot or arm, then full out jabs, body waves, turns and more. Many women try to map out their babies position, perhaps playing the "what's this" body part game. Maybe tracing down the spine, or maybe just gently placing your hand over the spot that protrudes dramatically as your womb and child grows.
Midwives and doulas (and maybe some GP's, or OBGYN's?) talk about optimal fetal positioning, and ways to reduce your chances of having a posterior baby at the time of birth. Maintaining a mild level of exercise (walking, swimming, yoga), reducing the amount of time you spent reclining deeply in a sofa or chair, when sitting, focus on sitting up straight or even better slightly forwards. Working with a Midwife over winter, she pointed out the number of posterior babies increase in the long cold winter months - as women are less active and spend more time in the home or work sitting.
What is occiput posterior?
Simply put the back of your baby's head (the occiput) is facing towards your back. A simple way to remember is "Back to Back". If baby is in the vertex position (head down) this means that your baby's legs are curled forward at your fundus (the top of your uterus), and that you will kicks up high and that they will likely be very forward in their strength, all up front. Very noticeable. If you try to palpate for position, you'd like feel all legs at the top half of your uterus, not being able to trace the spine from bottom down towards the head.
What does this mean for my pregnancy?
Basically nothing! Babies move and changes positions often while in utero. As your pregnancy progresses, it may be worthwhile to focus on some positions in your body, to encourage baby to turn into a OA (occiput anterior) position.
What does this mean for my labour?
It can mean a lot. Or nothing. There is lots of fear swimming around about OP babies, longer harder more painful labours, more epidurals, more use of forceps, vaccums, more c-sections. And it's often true, OP babies are more likely to have the above, but OA babies can too. Posterior babies can be born pain free (or, with little discomfort) just like OA babies. While I believe that focusing on optimal fetal positioning techniques is important and knowing if your baby is OP is extremly helpful is helping you get baby to turn, if you are birthing an OP baby, I might be the first to say it "you can do this".
What are some of the common markers in labour for an OP baby?
Many women complain of a deep back ache that doesn't let up after a surge (contraction) has passed. This is the back of your baby's head putting pressure on your pelvis. Other women birth with little to no extra discomfort - which often surprises the receiver (Midwife), as we have trained our minds to link the back pain to OP.
What can I do in labour?
Support. Having a knowledgable doula, friend or Midwife there is likely number one. When you are in labour the back ache can take up a lot of your focus over the surges, and having someone who knows methods to turn an OP baby is so invalueable.
Here are some things to try in labour:
- Pulsatilla, a homeopathic remedy. I've seen it work wonders. You can take this in pregnancy and in labour.
- Get off your back, laying in bed is about the worst position you can be in. If you need to be in bed for whatever reason, sit with your legs as open as possible, or side lay with your top leg open and propped with pillows.
- Side lunges, nothing fancy. Put one leg on a stair or chair and lean into that side with a support person and holding on. This opens one side of your pelvis beautifully giving your baby a bit more space to turn. Whatever side feels better, do that side. Inbetween or during contractions.
- Hands and knees, the back of the baby's head is the heaviest part, and by being on hands and knees you are encourage the occiput to rotate with gravy towards the navel, and into a OA position.
- Pelvis tilts (cat cow), while in hands and knees tuck your pelvis inwards towards your navel, then the opposite direction upwards.
- Visualization, in between contracts (or during) you can visualize your baby rotating into an ideal position, perhaps moved by an ocean wave, or other strong pull. Sliding easily and smoothly into the occiput anterior position.
- Sitting on (or leaning over) a birth ball, a birth ball is simply a yoga ball. By sitting upwards on it, and rocking, swaying and otherwise moving you are opening your pelvis and using motion, both will encourage an ideal position. By leaning over it, you can mimic a hands and knees position with less strain on your wrists, arms and shoulders.
- Walking, really isn't walking the back bone for issues related to labour? By walking and focusing on a wide stance (picture skating), you are opening your pelvis, using motion and gravity with you. While it isn't the most ideal position for gravity to help, it is still a great one.
- Pelvic Lift and tuck, linking the fingers under the belly and at the start of a rush (contraction) pull your belly upwards about 2 inches and inwards about the same, while trying to flatten your back (this should cause your knees to bend some).
- Robozo sifting, having a doula "sift you" can help release the ligaments and muscles that may be a contributing factor in your OP baby. You can also do the pelvic lift and tuck with a robozo and support person.
- Open-knee chest, a poorly worded position. It sounds as though I am implying you open your knees, when really you are trying to open the space betwen your knees and pelvis. In a hands and knees position drop your chest to the floor (using a pillow for support if needed) and keep your bottom up high, backing up your knees as much as possible without dropping your pelvis. At this point, a Doula or Midwife can use a Robozo to hold your thighs while in this position.
- Pancakes, yum! Well, not exactly. The idea for moving a baby is to move mama. Pancakes refers to flipping positions every 3 contractions in a sequence to help baby move. Ideally it goes, hands and knees (all positions for 2-3 contractions), laying on left side with right leg up and at 90 degrees, leaning forward slightly while still lying on left side, open-knee chest, laying on right side, laying on right side leaning forwards. Repeat. All of these can be done on a bed, so it can be a nice time to relax. Although, I will admit, not one of my clients has done the entire sequence fully even once. Labour often has a way of saying "shut up, I need to move", and I think it's way more important to listen to that internal voice than mine.
- Dangling, straddling on your partners (or doula's) lap facing them while they sit on a chair. This is often a great release for the pelvis floor which can release in helping baby turn. Add a bit of kissing for an oxytocin boost (your partner, not your doula!), and it's a lovely position.
- Sitting on the toilet, same as above but on the toilet. Naturally we are accustomed to releasing in this location. If you find you are clenching while sitting here, get off the can! You can try sitting backwards with pillows on the toilet tank, try it in pregnancy, it can be very comfortable.
In pregnancy:
- Remain active. I don't mean running half marathons just some gentle walking (like to the grocery store instead of driving), weekly prenatal yoga, or swimming.
- Reduce the amount of time you spend with your pelvis tucked up and your belly up, ie laying on the couch. I know, I know.
- Take pulsatilla if OP has been confirmed by a Midwife, or suspected by you.
- Aim for good posture as the months go on (this in return will also help back pain in pregnancy as your are strengthening your muscles.
- Ask your baby to turn OA daily. It may not work, but it also may! It also helps you connect with baby and keep in mind that labour in a journey together.
- All of the above tricks for OP in labour can and should be used in pregnancy! Do a few cat cows poses a day, maybe in bed before you get up for the day. Try the open-knee chest before bed. The more your practice in labour the more familiar they will be for labour, and the less likely you'll need to even use them.
- Ditch your office chair and grab a birth ball instead.
- Have your partner remind you gently (ohhhh, maybe by rubbing your lower back, yum!) to sit up, and even lean forward when at rest.
- Acupuncture or acupressure
- Chiropractor
- Massage therapist trained in myofascial release.
What to do if baby doesn't turn into an ideal position in labour?
If baby doesn't turn, baby CAN and WILL BE born OP. This refers to when the baby is born and mama is in the supine position (on her back, or close to) and baby is born looking upwards towards the ceiling often with eyes open - this apparently reminds care providers of a frying egg. Oh-kay. Ahem.
Some techniques to assist with any discomfort are:
- Water, a birth pool, bath or shower
- A birth ball
- Movement
- Counter pressure (also known as double hip squeeze, or as I typo every time the doula hip squeeze)
- A TENS unit (Transcutaneous Electrical Nerve Stimulation).
- Acupressure
- Reiki
- Robozo work
- An experienced doula or Midwife
- all the above positions to actually shift the baby's position
All these suggestions, tips and tricks can really help you have a lovely birth, but you can also have one without any of these, even with the dreaded occiput posterior baby. So, listen to your body and try to push aside the fear mongering you are fed daily. Take what feels right, and ditch the rest. You know your body and what feels right. Like I said before, labour has a way of telling you what you need to do, usually by screaming "that doesn't feel comfortable" at you.
Interested in learning more about baby's position in pregnancy and the birthing process, or unsure what some of the positions I mentioned are? Check out Spinning Babies.
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